6 simple tennis elbow exercises to soothe ongoing pain, according to a top physiotherapist

·8-min read
Photo credit: Elena Safonova
Photo credit: Elena Safonova

If you have tennis elbow, it makes sense that you might feel more comfortable with the idea of giving up all exercise than running the risk of making it worse and carrying on with workouts. Rest is always best, right? Well, not necessarily. Physiotherapy exercise is one of the main forms of treatment prescribed by the NHS, since it can ‘relieve pain and stiffness, and encourage blood flow to your arm’, while one study showed that eccentric exercise on the muscles involved in tennis elbow (i.e. lengthening them under load) reduced pain level from 79% to 15% after doing the exercises daily for seven weeks.

Naturally though, as is the case with sciatica exercises and knee arthritis exercises, the type and frequency of exercise you should do depends very much on the individual; how severe your pain is and which stage of recovery you’re at are just a few important factors to consider. This will also influence which arm exercises in general you’re able to do.

It’s a lot to get your head around, we know, which is why we called upon Karen Gambardella, a musculoskeletal physiotherapist for BUPA UK, to break down everything you need to know about tennis elbow exercises in as clear and concise a way as possible. Read on to find out how often you should do them, who should avoid them, and the best tennis elbow exercises to start with.

What is tennis elbow?

‘Tennis elbow, also known as lateral epicondylitis, is a common overuse injury that causes tiny tears in a tendon in your forearm (the common extensor tendon), that then thicken, swell and leading to pain,’ Gambardella explains.

‘The tears and swelling usually develop gradually, with their duration varying depending on how severe the symptoms are. However, the vast majority of symptoms resolve within a year.

‘Despite the name, tennis elbow can actually occur with any sport or activity involving repeated forearm use e.g. weightlifting.’

Tennis elbow symptoms

‘The most common symptom of tennis elbow is pain on the outer side of your elbow, which becomes more painful when you grip or make a fist. You may also feel pain when you extend your wrist or fingers,’ says Gambardella.

‘The condition usually affects your most dominant arm, but it is possible to get it in both arms. Symptoms can last anywhere between six months and two years, depending on how severe it is.’

How can exercise help tennis elbow?

As mentioned, the NHS advises that physio exercises can encourage blood flow to the area, which in turn relieves stiffness and pain. Gambardella adds that exercises can also ‘strengthen your forearms and elbows,’ which also reduce pain. She caveats, however, that a physiotherapist will be able to offer you more individual advice on the best exercises for you, ‘to help you safely return to your exercise routine’.

How often should you do tennis elbow exercises?

According to several studies and the NHS, once you have cemented which tennis elbow exercises are best for you, you will reap the rewards sooner if you do them daily. In fact, the NHS adds that ‘you must exercise regularly to stop your pain from returning’. That said, this is ‘dependant on the severity of your injury,’ according to Gambardella.

When should you avoid tennis elbow exercises?

Though the experts advise that doing tennis elbow exercises daily is generally your best bet, there are times when you should definitely ease off. ‘If you experience any sharp pain, stop doing them immediately,’ says Gambardella. ‘Then speak to a physiotherapist and explain your situation.’

What are the best tennis elbow exercises?

Before we go any further, Gambardella advises that whilst there are ‘lots of tennis elbow exercises that have the potential to help, they’re not always appropriate for everyone at every stage, and could make your symptoms worse.

‘Some exercises are better introduced later on in the recovery process and only once your pain tolerance allows.’

For that reason, Gambardella advises that the eccentric elbow strengthening exercise (number 2) and the weighted supination (number 6) are a ‘solid place to start’, adding that when – and only when – you feel like you could increase the intensity of your exercises should you start to consider adding in the other exercises below.

1.Isometric wrist extension

  1. Position your painful arm resting on a table.

  2. Pull your hand back towards you so that your fingers are pointing to the roof.

  3. Bring your non-painful hand and gently place it at the back of your hand pointing towards the roof. Gently push for 10 seconds.

  4. Repeat 5 times and repeat 4 times per day. If this exercise brings on pain then you are pushing too hard so slightly ease off your push.

2. Eccentric elbow strengthening exercise

  1. Take a light hand weight, e.g. 1kg or 500ml water bottle and head over to a table.

  2. Lay your affected arm over the side of the table so that your palm is facing downwards, holding the weight.

  3. Use the hand that isn’t painful to slowly raise your painful hand upwards until it is level with the table, remove the assistance of the other hand and then gently lower the panful one back to the starting position.

  4. Repeat this 10 times, aiming to complete three sets in a day once your pain allows you to.

3. Concentric elbow strengthening exercise

  1. Position your painful arm on a table with your palm facing downwards.

  2. Hold a small hand weight (or can or bottle of water) then slowly raise the weight towards the ceiling and then lower back to the starting position.

  3. Repeat 15 times as your pain allows.

4. Wrist extension

  1. This exercise can be done standing or sitting. Hold a broom handle or walking stick in both hands.

  2. Lift your arms to shoulder level. Keep both elbows straight with your palms facing down.

  3. Roll the broom handle backwards like you are trying to reel something in. Repeat 15 times twice per day.

5. Towel twist

  1. Sit in a chair with your arms at shoulder level holding a rolled up towel in both hands. Keep your elbows straight out in front of you.

  2. Twist the towel so you are turning the painful wrist towards the floor. Repeat 15 times. Then slowly increase to 3 sets of 15 repetitions as pain allows.

  3. To progress this exercise then twist the towel in opposite directions like your are trying to wring water from the towel.

6. Weighted supination

  1. Sit in a chair next to a table, using a small hand weight (like a can or a water bottle).

  2. Holding the weight with the hand of your sore arm, lay your arm over the table so that your outer wrist is resting off the end of the table, leaving your weight to hang vertically.

  3. Next, rotate your hand outward, turning the palm upwards. Rotate your hand in the opposite direction so your fist faces forwards, then slowly backwards to the starting position.

  4. Repeat this 10 times, once a day until you feel confident enough to increase this to three sets per day.

How can I make my tennis elbow exercises more effective?

Feel like you’re not getting anywhere? Gambardella advises that you’ll see the best results from your tennis elbow exercises if you tackle them with a progressive overload approach. ‘Build them up slowly and gradually so that you become stronger over time,’ she says. Here’s how:

  • Start with 1 set of 10 reps per day, then build up to 2 sets, then 3, as and when you feel ready, then increase the number of reps per set from 10 to 15.

  • Start with your lightest weight (1 or 2kg), then increase by 1kg per week as and when you feel capable.

  • Introduce more complex exercises as and when you feel ready.

Here’s how to know when you're ready to step things up a notch: ‘You’ll probably feel some discomfort when doing the exercises you're already dong, but you won’t have any sharp pain and your discomfort won’t last very long after doing the exercises,’ says Gambardella. If you are feeling any sever, sharp or lasting pain, upping the intensity is only going to make your symptoms worse.

Of course, exercise isn’t the only thing that can improve your tennis elbow symptoms, and combining your exercises with other techniques could be useful. Gambardella recommends the following:

1.Review your activity

‘Look at what activities may be contributing to your symptoms and see if there are any ways to reduce or modify them. For example, take a break from exercises requiring repeated gripping such as racket sports or lifting weights, or consider an ergonomic mouse at work if computer work exacerbates your symptoms.’

2. Consider pain control

‘If pain is affecting your daily activities, such as use of the computer mouse or carrying bags of shopping, it may help to discuss this with your GP for advice on pain control.’

3. Using a tennis elbow brace

‘This will apply light pressure to the affected tendons within the forearm. This pressure helps to reduces the amount of contraction taking place within the forearm so that it doesn’t hurt as much, for example, when making a fist. Make sure you don’t wear your brace too tightly – it shouldn’t cause any numbness or tingling into the forearm and hand.’

4. Try physiotherapy

‘This will allow for your symptoms to be assessed to confirm whether it is tennis elbow causing your forearm/elbow pain. A graded exercise programme can then be implemented to strengthen the wrist extensor muscles and guide your return to activity.’

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